Tracking of payments made for medical, dental and other healthcare services can be exceedingly difficult and complex, particularly with respect to payments made by, or on behalf of, a patient. For example, a patient covered by a healthcare insurance policy may make a co-payment at the time a healthcare service is rendered. The co-payment may be paid by a variety methods including by check, cash, flexible spending account card, creditcard, debitcard, voucher, electronic funds transfer. Alternately, the patient may choose to wait for the healthcare insurance provider to pay the healthcare service providers' submitted claim and then reconcile the remaining balance with the healthcare service provider after the healthcare service provider has been paid by the healthcare insurance provider.
To further complicate payment tracking, a single insurance claim may be divided among several healthcare service providers. For example, a primary care physician (PCP) may prescribe medications, order diagnostic tests, recommend specific treatments, and/or refer the patient to a specialist. The specialist may order additional diagnostic tests such as X-rays, CT scans, MRI scans, laboratory tests, etc. to determine a proper course of treatment. In many instances, the patient pays for each of these services separately by one or more of the methods described above.
Typically, each healthcare service provider also submits a separate claim to the patient's healthcare insurance provider. Assuming there are no issues, for example, improper healthcare procedure coding errors, with the submitted claim(s), the healthcare insurance provider pays the submitted claims in due course. Often this process is mostly transparent to the patient until an explanation of benefits (EOB) arrives in the mail. An EOB generally provides information related to the submitted claim, such as dates of service, insurance coverage, payments made or denied, etc. However, many patients find EOBs difficult to understand.
On many occasions, the patient may also receive an invoice from one or more of the healthcare service providers stating that the healthcare insurance provider refused payment for a portion, or all of, the submitted claim(s). These refusals can occur for any of a multitude of reasons including, but not limited to: the patient not meeting an annual deductible limit; the services rendered by the healthcare service provider not being covered by the patient's healthcare insurance policy and/or healthcare insurance provider; improper procedure coding; an error on the part of the healthcare insurance provider, the healthcare service provider, and/or the patient; maximum allowed benefits having been exceeded; or any other reason deemed appropriate by the healthcare insurance provider.
To further exacerbate the situation, the EOBs often arrive before, or after, the healthcare service provider's invoice. Consequently, it is often difficult for a patient, a healthcare service provider, or a healthcare insurance provider, to effectively determine what transactions have transpired related to a particular healthcare event. Moreover, given the frequently long time spans between the rendering of healthcare services and receipt of EOBs and/or healthcare service provider invoices, the receipts initially received by the patient at the time the healthcare services were rendered are often misplaced, lost or discarded, by the time an issue arises, thus making resolution of a payment issue exceedingly difficult and often leaving the patient in the untenable position of having to rely on the records of the healthcare insurance provider and/or healthcare service provider to verify proper payment of claims, reimbursements and applicable policy considerations (e.g., deductibles.)
Accordingly, due to the potential number of separate transactions, extended time periods between the transactions and reports associated with transactions, differing payment methods, frequently incomprehensible explanation of benefits (EOBS), patients, healthcare service providers, and healthcare insurance providers alike are frequently frustrated by the difficulties presented in resolving discrepancies and/or payment matters.